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“Ovarian cancer” is a generic term for any primary malignant ovarian tumor. However, ovarian cancer is not one disease. There are many types of ovarian cancer, including some that are extremely rare and require specialized treatment. Therefore, establishing the correct diagnosis upfront is very important. The main types of ovarian cancer are named for the cells where the disease first forms.
Epithelial ovarian cancer: About 90% of ovarian cancers start in the epithelium tissue; these cancers may come from the fallopian tube or from cells in the ovary. These may also arise from tissue that has implanted on the ovary. For example, endometriosis attached to the ovary may turn into endometrioid (carcinoma). This type of ovarian cancer is divided into many subtypes, including serous, mucinous, endometrioid, clear cell, transitional and undifferentiated types. The risk of epithelial ovarian cancer increases with age, especially after the age of 50.
Germ cell ovarian cancer: Germ cell tumors account for about 5% of ovarian cancers. They begin in the egg-producing cells. This type of ovarian cancer can occur in women of any age, but about 80% are found in women under the age of 30. The main subtypes are teratoma, dysgerminoma, endodermal sinus tumor and choriocarcinoma.
Stromal ovarian cancer: These tumors represent about 5% of ovarian cancers. They grow in the connective tissue that holds the ovary together and makes estrogen and progesterone. Most are found in older women, but sometimes they occur in girls.
Stromal tumors usually do not spread as fast as other ovarian tumors. Subtypes include granulosa, theca and Sertoli-Leydig cell tumors.
Primary peritoneal ovarian cancer is a rare cancer. It has cells that look like high-grade serous ovarian cancer, but it starts in the lining of the pelvis and/or abdomen. Women can get this type of cancer even after their ovaries have been removed. Symptoms and treatment are similar to those of epithelial ovarian cancer.
Ovarian cancer screening
Ovarian cancer screening is recommended only for women at increased or high risk.
Being at increased risk does not mean you will get ovarian cancer. But it does mean you should start regular screening exams to detect cancer if it develops. When found early, the chances for successfully treating the disease are greatest.
You can find out more, including who is at increased risk and how to schedule a screening, on our Ovarian Cancer Screening page.
Ovarian cancer risk factors
Anything that increases your chance of getting ovarian cancer is a risk factor. These include:
- Age: The risk of ovarian cancer increases with age. About half of ovarian cancers are in women over 60.
- Family history of ovarian cancer
- One close relative with ovarian cancer who has a suspected BRCA1 or BRCA2 mutation
- Genetic factors: Approximately 10% to 15% of ovarian cancers are due to genes that make you more likely to develop cancer. These include:
- BRCA1 or BRCA2 mutations or suspected risk of BRCA1 or BRCA2 mutations
- Lynch syndrome (hereditary nonpolyposis colorectal cancer)
- Never having children. The more children you have, the less likely you are to develop ovarian cancer.
Not everyone with risk factors gets ovarian cancer. However, if you have risk factors, it’s a good idea to discuss them with your health care provider.
Some people have an elevated risk of developing ovarian cancer. Review the ovarian cancer screening guidelines to see if you need to be tested.
Some cases of ovarian cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Learn more about ovarian cancer
MD Anderson is #1 in Cancer Care
On Feb. 6, 2020, I was diagnosed with stage IIIc ovarian cancer. The abruptness of it all was shocking. In an instant, I was snatched from the warm, comfortable life I’d been enjoying and dunked into the icy cold waters of a nightmare. I felt unable to breathe.
My family doctor, as well as the gynecologist who diagnosed me, seemed equally shocked. Few words were exchanged between us, but their faces spoke volumes. I was convinced there was little hope for me.
That’s why I’m so glad I went to MD Anderson. There, I not only found the immunotherapy clinical trial that ultimately saved my life. I also found an entire team of experts who took charge of my treatment and never gave up.
My ovarian cancer diagnosis
I’d thought I was perfectly healthy before my ovarian cancer diagnosis. I didn’t have any ovarian cancer symptoms – just a little pain while urinating. I chalked that up to a UTI and went to my regular doctor for some antibiotics.
But my doctor said it wasn’t a bladder infection. He sent me off for a CT scan. The next day, he called to tell me the results: I had a mass the size of my fist on my right ovary. Even worse, it looked like it was spreading. He suspected it was ovarian cancer. I needed to contact my gynecologist right away.
Why I chose MD Anderson for ovarian cancer treatment
At first, I was convinced that someone had made a mistake. Maybe someone had mixed up my scan with another patient’s.
Unfortunately, my gynecologist confirmed I had cancer. Then, she suggested I go to a nearby hospital system for treatment. That recommendation struck me as odd, considering I live only an hour away from the nation’s #1 cancer hospital. Why wouldn’t she send me straight there? I took that as another depressing sign that she felt there was no hope.
I went to MD Anderson anyway. I knew that people came from all over the world to be treated there. And, I’m convinced that decision is the reason I’m still alive today.
I found hope at MD Anderson
It turned out that MD Anderson had just opened up a brand new facility in The Woodlands, about 15 minutes away from where I live. During my first meeting there with gynecologic oncologist Dr. Lauren Cobb, I remember crying and feeling an overwhelming sense of doom.
But she and her team turned my entire perspective around within minutes. She hugged me and told me not to worry, that we were going to get through this together. They were all so calm and supportive.
Dr. Cobb’s approach to my disease changed everything. I left my appointment that day feeling full of hope. I was no longer alone.
My ovarian cancer treatment
I told Dr. Cobb that if she would be in charge of my disease, I would not attempt to become Dr. Search Engine. I would do my part by focusing only on my spiritual and emotional health. I would be optimistic and do everything asked of me — and I would not give up.
She said that the first part of my treatment would be an 8-hour debulking surgery, to remove as much of the disease as possible. Then I’d undergo multiple rounds of chemotherapy. Eventually, I would join two clinical trials, too. But none of those slowed the cancer down for very long.
Then, Dr. Cobb told me about a new clinical trial led by Dr. Shannon Westin. It was designed for patients with clear cell ovarian cancer; it combined a new immunotherapy drug called etigilimab with an older one called nivolumab.
I didn’t know much about immunotherapy at the time, but I loved the idea that it was my own body doing the work. It would get help from the drugs, of course, but all the heavy lifting would be done by my immune system.
What got me past the setbacks
Unfortunately, before I even got my second infusion, my body stopped cooperating. Lab tests showed that my cell counts were too low to continue treatment. I was so fatigued that I could barely walk from one appointment to the next. I felt overwhelmed, defeated and helpless.
But Dr. Shannon Westin and Dr. Amir Jazaeri would not give up. They talked me through all the setbacks, listened to me and gave me hope. They also put everything in motion to build me back up for the next infusion, including multiple blood transfusions and massive amounts of iron.
By this point, I was starting to think I wasn’t going to make it. I was so sick that I had to be hospitalized twice. I couldn’t walk to the bathroom or even get up by myself. I also couldn’t eat, and felt really uncomfortable, with a bloated belly full of tumors.
But my blood counts finally rebounded enough that I was able to continue the clinical trial. And, after the third immunotherapy infusion, I started feeling remarkably better. By the eighth infusion, I felt fantastic. Some of my tumors were gone, too, while others were visibly shrinking. I never had any side effects.
Living well with stage III ovarian cancer
I am 100% sure I’d be dead right now if I hadn’t gone to MD Anderson. The experimental treatment I got there saved my life. And, the level of care I experienced there is unmatched. I cannot imagine having a better or more personalized treatment anywhere else.
I’ll stay on this clinical trial for another year or so. If the drugs keep working, I hope to continue taking them, even after the trial ends.
But even if they stop working one day, I’m not worried. I know that my MD Anderson doctors always have something else up their sleeves. And their positive attitude helps me to stay positive. I won’t give up, since I know they’re not going to.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
A woman could have her fallopian tubes removed for any number of reasons. Sometimes, it’s necessary to treat an ectopic pregnancy or to resolve an infection caused by pelvic inflammatory disease. In other cases, it’s done as a form of permanent birth control.
But a growing body of evidence suggests that the distal fallopian tube — or flower-shaped section located nearest the ovary — is the site of many cases of high-grade serous ovarian cancer, the most common type of ovarian cancer and one of the most aggressive.
Research also suggests that an opportunistic salpingectomy — the complete removal of the fallopian tubes during an unrelated pelvic surgery — could help reduce the chances of one day developing ovarian cancer.
So, who should consider having their fallopian tubes removed, and when? And, should anyone who’s finished childbearing seek out the procedure, even if they’re only at average risk of ovarian cancer? We asked Michaela Onstad-Grinsfelder, M.D., a surgeon specializing in gynecologic cancers.
Why do women typically have their fallopian tubes removed?
Women don’t usually go in just to have their fallopian tubes removed unless it’s for permanent birth control or to treat an ectopic pregnancy.
Having the fallopian tubes removed is one form of surgical sterilization, or “having your tubes tied.” Until fairly recently, it was more common for surgeons to use a metal clip or a ring to constrict and physically block the tubes, rather than removing the structures themselves.
Why has that changed?
A growing body of data suggests that the fallopian tubes may be the origin of many ovarian cancers. So, a lot of surgeons have changed their practice to remove the fallopian tubes entirely to give patients additional protection against ovarian cancer.
In the United States, the Society for Gynecologic Oncology and the American College of Obstetricians and Gynecologists both support the removal of fallopian tubes as permanent sterilization for women at average risk for ovarian cancer, but it’s also recommended by professional organizations in Australia, Canada, Germany and New Zealand.
How was this information discovered?
After the BRCA gene was linked to an increased risk for breast and ovarian cancers, doctors started removing the ovaries and fallopian tubes as a type of risk-reduction surgery, once BRCA-positive women were finished with childbearing.
Most ovarian cancers are diagnosed at stage III or IV, so we don’t usually see the disease in its earliest stages. But what we noticed when we started performing these surgeries is that there were often pre-cancerous lesions present in the fallopian tubes.
This was a really exciting discovery because, before that, we hadn’t known there was a lesion that could one day become ovarian cancer. So, we were able to start finding ovarian cancers really early that we hadn’t been able to catch before.
How did that discovery lead to the recommendation of opportunistic salpingectomies?
There was a lot of excitement in the medical community at that point about the possibility of reducing the risk of ovarian cancer by removing the fallopian tubes during hysterectomies or when patients were having their “tubes tied.” Before that, whenever someone had a hysterectomy, we would normally only take out their fallopian tubes if we were also taking out their ovaries.
But as the new data emerged, there was an increased interest in removing the fallopian tubes along with the uterus when performing hysterectomies. Because if a woman is pre-menopausal, her ovaries might still be benefitting her. But once she’s finished childbearing, the fallopian tubes serve no real purpose.
So, who should consider having their fallopian tubes removed?
People who are at increased risk of developing ovarian cancer, such as those who carry the BRCA genetic mutation, are recommended to have a stand-alone surgery to remove fallopian tubes with both ovaries (called a risk-reducing salpingo-oophorectomy).
Otherwise, it’s only recommended as an opportunistic salpingectomy: something to be done when you’re already having another type of gynecologic procedure, such as a hysterectomy.
Are any related clinical trials available?
We have a clinical trial going on right now for BRCA-positive women who are done with childbearing but are not quite ready to have their ovaries removed.
In this clinical trial, participants will have their fallopian tubes removed now, but delay the removal of their ovaries until later (between the ages of 35 and 45 for patients with BRCA1 and between the ages of 40 and 50 for those with BRCA2). The goal is to determine if it may be safe to delay the removal of both ovaries for women at high risk of developing ovarian cancer.
Do you ever foresee a time in which an opportunistic salpingectomy could be combined with another procedure, such as an appendectomy or a hernia repair?
Right now, we don’t typically bundle other types of surgeries with the removal of fallopian tubes. That’s partially because only OB-GYNs are specifically trained in that procedure.
But we’re actively looking for ways to team up with other surgeons to offer this service together. It could be an exciting strategy in the future to further reduce patients’ risk of ovarian cancer.
Request an appointment at MD Anderson online or by calling 1-877-632-6789.
Why choose MD Anderson for ovarian cancer treatment?
A team of some of the nation's top experts works together to address your specific condition when you come to MD Anderson's Gynecologic Oncology Center for ovarian cancer treatment and diagnosis. This team includes gynecologic oncologists, radiologists, radiation oncologists, surgical oncologists and pathologists. They are joined by a support staff trained to provide the highest level of ovarian cancer treatment.
This group follows you every step of the way, communicating and collaborating closely to deliver outstanding care. Their aim is to deliver the most advanced, minimally invasive ovarian cancer therapies while limiting side effects as much as possible.
Ovarian cancer care planned just for you
Your treatment for ovarian cancer is personalized to include leading-edge technologies and techniques. These may include advanced surgical procedures, chemotherapy options and targeted therapies. In addition, we offer treatment for benign (non-cancerous) tumors of the ovaries.
We are one of the most active centers in the nation for the treatment of rare ovarian cancers and relapsed ovarian cancer cases, offering the highest level of care that can include clinical trials and innovative approaches such as targeted therapies.
Surgery often is needed for an ovarian cancer diagnosis, but it is important to carefully consider the timing of surgery. Because MD Anderson is a leading cancer center with one of the most active ovarian cancer programs, our surgeons have a high level of expertise that sets them apart from many others. The MD Anderson physicians will carefully consider whether it is better to do surgery upfront or after chemotherapy.
Rare ovarian cancers
Many rare ovarian cancers have distinct molecular and clinical features. An accurate diagnosis is essential for getting the right care. The pathologists at MD Anderson are experts in diagnosing rare ovarian cancers. When patients are diagnosed with one of these rare cancers, they get care from gynecologic oncologists who specialize in that particular disease.
We are leaders in studying ovarian cancer on the molecular level and translating research into advanced ways to find and treat the disease. Through our High-Risk Ovarian Cancer Screening Clinic and Gynecologic Cancer Genetics Clinic, we offer genetic testing for women with hereditary breast and ovarian cancer syndrome and other high-risk inherited conditions.
MD Anderson leads the nation in innovative research into the causes, prevention, detection and treatment of ovarian cancer, including rare ovarian cancers. In fact, we are one of the few cancer centers in the nation to house a prestigious federally-funded Ovarian Cancer SPORE (Specialized Program of Research Excellence) program. This means we offer a variety of clinical trials of new ovarian cancer treatments.
And, at MD Anderson you're surrounded by the strength of one of the nation's top comprehensive cancer centers. We have all the support and wellness services needed to treat not just the disease, but the whole person.
Going through cancer gives you an opportunity to see what you're made of.
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Prevention & Screening
Many cancers can be prevented with lifestyle changes and regular screening.